Background and objectives: Aid in dying (AID) means assisting a person in their voluntary death. Despite a trend toward AID legalization, knowledge on how AID decisions (should) unfold is limited. We synthesized the current scientific understanding of interactional AID decision-making processes in the healthcare context. Methods: For this scoping review, we searched Web of Science, PubMed, and CINAHL. Records were that reported own results on interactional AID decision-making processes in healthcare were eligible. Study designs or populations were not restricted. Data was extracted and synthesized with a structured excel sheet by three researchers. Results: We identified 109 eligible records with diverse study designs and populations. They mentioned various participants in interactional AID decision-making processes, some specifically trained. Organizational and system characteristics also influenced such processes. Records described a longitudinal and iterative process, including several phases (beginning, assessment, preparation, realization, aftercare) and overarching themes (coordination, patient-centered care, inter-/multidisciplinary teamwork). A range of decisions were identified that need to be made by different stakeholders throughout the process. This complex process requires appropriate communication skills. Examples of facilitators were a trusting pre-existing patient-clinician-relationship, guidelines, and an open, non-judgmental attitude. Examples of challenges were power imbalances, clinicians' subjective interpretations, and insufficient self-reflection. Future research to better understand and improve AID processes was called for. Conclusion: Several publications explored interactional AID decision-making processes. Our comprehensive synthesis is a start to painting a comprehensive picture, e.g. in a scientific model. The knowledge gained can structure future AID research and inform implementation efforts.

The authors have declared no competing interest.

This work was supported by the Research Promotion Fund of the Medical Faculty of the University Hamburg (grant number NWF-22/02). The sponsor did not have a role in study design; data collection, analysis, and interpretation; writing of the article; or the decision to submit it for publication.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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All data used in this scoping review is either published within the included records or added to this publication as supplementary material.